Post-Sterilization Intimacy: Sex after a Vasectomy

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It's normal to have a lot of questions about how a vasectomy might impact sex, scarring, and libido. Here are some of the most common ones:

Will a vasectomy affect the sex drive or ejaculation?

No. The procedure works by preventing sperm from mixing with semen, but because it doesn't affect hormone production there should be no change in sex drive after a vasectomy. Nor should there be any change in ejaculate. Sperm comprise only 2 to 5 percent of the fluid released at ejaculation, so removing them has little to no effect on the volume, appearance, color, or consistency of seminal fluid. (According to one study, cigarette smoking appears to have more of an effect on semen volume than a vasectomy.)

Does a vasectomy lower testosterone levels?

No. Although testosterone is produced in the testes--the same organ that generates sperm--the connection ends there. Sperm must be transported through the vas deferens to the seminal vesicles, where they're mixed with fluids to create semen. Testosterone, on the other hand, is secreted from the testes directly into the bloodstream and its production and release is completely unaffected by the vasectomy procedure.

Does ejaculation after a vasectomy feel different?

Because the volume of semen changes so little, and because hormone production and the associated pathways remain the same, ejaculation after a vasectomy should feel no different than it did before. You should still experience just as much pleasure from orgasm, and should not notice a change in quality, intensity, sensitivity or duration of orgasm after the procedure.

How long until I can resume sex after a vasectomy?

Your testicles will continue to produce sperm after a vasectomy, but now instead of mixing with semen they are mostly reabsorbed by the body or travel through the vas deferens tube until they reach the blockage and can't go any further. Sperm can also build up in the epididymis, and when this happens small blockages and scarring can occur. (But this rarely causes symptoms and men are usually unaware that this is happening.)

It can take six weeks or longer--between 10 and 20 ejaculations--for the sperm remaining in the unblocked portion of the vas tube to be completely reabsorbed or eliminated via ejaculation. Your physician will perform the first sperm-count test about six weeks after the surgery and will continue to do them until your sperm count is zero. Until then, you or your partner should continue to use some other form of contraception.

Physicians usually suggest waiting until a week or two after the procedure before resuming normal sexual activity--basically, until you are comfortable and can ejaculate without pain. But keep in mind: It will take additional time before your sperm count is zero, and until then it's still possible to get someone pregnant. It's important to use an alternate form of birth control until a semen analysis confirms that there are no sperm in your ejaculate. The first semen analysis is usually first obtained at the two- to three-month mark. If any sperm are present, your urologist will continue testing your semen until it's completely sterile. Click here for more information about what to expect after the vasectomy procedure.

Does the vasectomy procedure leave scars?

No. Vasectomies leave virtually no scar or noticeable difference to the feel or appearance of the scrotum.

Can a vasectomy make you more or less susceptible to sexually transmitted diseases?

Sexually transmitted diseases are transferred in body fluids, such as saliva or semen, and vasectomy surgery does not alter your ability to transmit or contract any of these infections. Use a condom if there is a potential risk for either partner to contract an STD.

Does the first time ejaculating after a vasectomy hurt?

No, most men do not experience pain when ejaculating the first time after their vasectomy surgery. The scrotum itself may still be sensitive, but the procedure itself does not create any circumstances that would cause discomfort with first ejaculation.

Some men experience a condition called post-vasectomy pain syndrome, which occurs when sperm backs up into the epididymis and causes discomfort on ejaculation, but such a side effect is relatively uncommon. (Click here for more information on side effects.)

Barone M.A., Nazerali H., Cortes M., Chen-Mok M., et al. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision.? Journal of Urology. 2003; 170(3):892-896.